Cataract surgery and intraocular lenses in patients with unsuspected malignant melanoma of the ciliary body and choroid.

During a recent four-year period, 21 patients were referred to the Oncology Service at Wills Eye Hospital with previously unsuspected posterior uveal melanomas in an eye that had been operated upon for a unilateral cataract. Twelve of the 21 patients had undergone standard cataract extraction and nine had had implantation of an intraocular lens, which was often in juxtaposition to the unsuspected melanoma. Preoperative ultrasonography in these patients had apparently been performed only to obtain an axial length of the globe and the eye was not scanned for pathologic processes in the posterior segment. Management of the melanoma included a cobalt plaque in eleven cases, enucleation in five, periodic observation in three, iridocyclochorioretinectomy in one, and orbital exenteration in one. It is stressed that a thorough external and slit-lamp examination, transillumination, carefully performed ultrasonography and, if necessary, a radioactive phosphorus uptake test can establish the diagnosis of uveal melanoma and prevent diagnostic delay and misdirected therapy in such cases.